Saturday, November 22, 2014

Mental
health still remains one of the most taboo subjects within modern society
today; sufferers are often left feeling alone and marginalised. However, recent
campaigns have come to public attention in order to tackle the very real issue.
The same cannot be said for mental health within the prison system, very little
is reported in terms of statistics and authorities tend to attempt to brush the
issue under the carpet.

There is
however a wealth of research regarding mental health and its dominance in the prison
system. As a result, there is actually a shocking number of individuals who
suffer with mental health issues. As many as 70% of the UK prison population
has two or more mental health disorders (Social Exclusion Unit, 2004). The
research also found that male prisoners were 14 times more likely to have two
or more disorders, and women were a staggering 35 times more likely than the
general population.

An article
published in September by the Independent detailed the terrifying rise in
prison suicides in the last year, with a percentage rise of 64%. As more
individuals with mental health issues make their way into the prison system,
both staff and facilities struggle to cope and prisoners suffer as a
consequence.

There are
several measures required in order to tackle the taboo subject, as well as
practical legislation needed. At a grass roots level it is so necessary that we
as a society accept the fact that people are affected by mental health. I would
hope that most people are aware that 1 in every 4 people will be affected by a
mental disorder in their life. This statistic alone is enough to see why so
many prisoners mental health suffers. A high percentage of the prison
population comes from areas of poverty, low employment, poor education and difficulties
or violence at home, all these issues coupled together is a recipe for mental
instability. Therefore encouraging people to recognise and acknowledge that
something must be done in order to tackle this overwhelming issue is really
important. Furthermore, the Prison Service introduced suicide and self-harm
procedures almost a decade ago, perhaps it is time for a review of the measures
considering the alarming rise in mental health related incidents, including
better implementation of these procedures by all staff, as well as those
trained specifically for the purpose of harm prevention.

On the other
hand we should emphasise the fact that staff are able to ‘tackle the issue’ and
save prisoners from harming themselves further everyday, and that perhaps despite
the real negatives of an increase in those harming themselves due to mental
health issues, there are many who are able to stabilise or overcome their
difficulties and this is because of prison staff. It is so very important that
we remember to praise those who are helping to rehabilitate prisoners every day
and that this rise in mental health issues is because a lack of societal faith
in our prison system can sometimes creep into the system itself.

Thursday, September 18, 2014

With a focus on adolescence, Bernadette Madrid, from the Univeristy of the Philippines and Director of the Child Protection Unit, highlighted the fact that this stage in life is a critical period in the life course. She made a very interesting point that, "no matter when we intervene in childhood; primary, secondary, or tertiary, ultimately it is all primary intervention for adulthood and for the next cycle of violence (family)". I thought this was a really interesting point to make because it requires a broader thought process that forces us to really consider the longer term objectives. It also fits nicely into the concept of reducing violence 50% in 30 years because it highlights that if we start to focus on violence reduction and intervention in adolescence, then we are essentially instilling primary prevention for those who will potentially parent the children of the next generation. If we do not think about the cycle of violence, then we will constantly play catch up.

Another really interesting point was made about the development of a research capacity in developing countries. Developing countries are working with very limited resources and politicians that are attracted to structural reform (improving schools, unemployment etc). However, because of the electoral cycles, issues such as dealing with the 'disconnected youth' in developing countries (child trafficking, sexual exploitation, etc) are not prioritised.

Bernadette made a few recommendations on what we need to do to improve the means and resources for research in developing countries.

1)We need to have universal access to secondary school education : This includes having young people complete high school which is of good quality and improve links to employment. Graduating highschool was found to have links with decreasing other negative life outcomes (marrying when young, re-victimisation of abuse)

2) Universal Access to Mental Health: Mental health problems affect 10-20% of children and adolescents worldwide, but in many low medium income countries, no psychosocial resources exist (Philippines as an example). There needs to be a promotion of interventions and socio-emotional development which includes developmental problems such as ADHD.

3) Reorganisation of services for better intervention and collaboration: We need to collaborate, engage citizens, independent agencies and experts.

4) Collaborate to increase the capacity in prevention and implementation research: This includes making cultural adaptations to traditional risk factors and research, but also to consider that there are many steps that need to be made before programmes can be implemented. For example, Bernadette attended some training on DNA data bases in America, and when she went back to the Philippeans she was told that in order to consider the database, there was first a need to develop the infrastructure such as where to store the DNA, the tools to collect the DNA, etc etc. All things that did not exist and make building the research capacity important.

In her final thoughts, Bernadette recommended the use of technology and music to begin to shape the views of violence prevention. These are things that already exist and can be further developed if we can make the cultural adaptations. Technology can be used in a rule of capacity training, and music can be used as a method of communication within communities as it's effective and is something that goes straight to an individual's emotion.

Theresa Betancourt is from Harvard University and is an Associate Professor of Child Health and Human Rights as well as the Director of the Research Program on Children and Global Adversity. For many years Theresa has been working in Rwanda and Sierra Leone as a means to study war-affected you and family strengthening intervention. In the 5 minutes I have to write this post, I will be able to make the slightest dent in the complexities that are involved in these two projects so please visit vrc.crim.cam.ac.uk to read her abstract and find out a bit more about her.

Theresa begins by highlighting the fact that 1/3 of children under the age of 5 are failing to fulfil their developmental potential which is problematic because as we know, childhood adversity often leads to adult chronic health problems. To create effective interventions, Theresa argues that we need to consider both risk and protective factors but from a collaborative approach. There are programmes that already work with families, but we need to come together to include what we know about protective factors across the sector.

Theresa mentions 'silo-busting' which the need to develop a holistic approach to child health. Part of this approach includes a rights based model called SAFE which is about Safety, Access to physiological care, Family, and Education. We need to use SAFE to create a basic safety net for children because "a weakness or a threat in one domain can have cascading effects on other domains".

Later in her presentation, Theresa mentions the importants of stress receptors in young people. She presented three levels of stress; 1) Positive (school plays, giving a presentation). This is positive because eventually with enough repetition, these acts don't produce as much stress. 2) Tolerable (serious and temporary but buffered but supportive relationships). 3) Toxic (prolonged activation of the stress response system and absence of the buffering factors found in stage 2).

The argument is that we need to focus on stress and this should be implemented in parenting interventions as well. We need to look at building self-regulation and stress management. We need to keep the pressure on governments to keep funding and developing policy, research evaluation and multi-sectorial collaboration.

Dr. Alexander Butchart is the Prevention of Violence Coordinator in the Department of Violence and Injury Prevention and Disability at the World Health Organisation. His discussion surrounded the topic of my Global Violence Prevention Field and outlined some of the objectives of what we need to do to create this. One topic which was discussed during the question period had to do with the definitions of violence that we should prioritise in our research. Alexander recommended that we look at interpersonal violence as this affects all countries and leads to risk factors for lifelong risks to health and social problems.

His recommendation for creating a Violence Prevention Field is that we involve international actors, intellectual, institutional and financial links all with a shared focus on evidence-based control. To do this, we need to think realistically about whether or not we are able to create global objectives or global baseline targets. I agree that it's unrealistic to frame this approach around the need to meet targets and set objectives that everyone needs to work towards. I also agree with Alexander that what we need in order to move forward is collaboration with the basics which includes creating surveys that not only include economic, public health and family factors. We need surveys that also work to collect information on violence, aggression and protective factors.

It was interesting to have the discussion of risk factors, or what the higher income countries have defined as risk factors. When we are researching the low medium income countries, we really should be asking ourselves whether or not the same risk factors apply.

What must be done? We need to advocate for a global political prioritisation of violence prevention, integrate knowledge and skills and promote peace and non-violence in education programmes.

Today's conference begins with setting the Conference objectives and reminding everyone of the reasons why we have some together these two days. As discussed in previous posts, we are looking to bring together different approaches from Public Health to Criminology. Manuel Eisner reminds us that we are striving to work together as a means to reduce violence globally by 50%. He makes the point that this is the opportunity to move Violence Prevention up on the list of priorities, globally. We need to use this time to consider what need to be done over the next 10, 20 and 30 years to reach these objectives. Manuel mask the valid point that this is a room full of people who have very 'strange ideas' and are not afraid to share those ideas. But as a group, we need to work together and realize that Capacity Building need to be central to our efforts. This includes working in low/middle income countries and working with young scholars from those countries as they are the future. This is why various Bursary Scholars have been invited from low and middle income countries to attend the conference and share their research at the poster presentations. This is a conference that acts on what they have recommended, instead of just talking about it.

Etienne Krug, who is the Director of the Department of Violence and Injury Prevention and Disability at the World Health Organisation, welcomed guests with a clear statement that this is our opportunity to to continue to bridge the gap between Public Health and Criminology, and "it is up to us to convince the rest of the world that this can be done" and we can achieve our goals to reduce violence, globally. The emphasis was that we need to "develop a Global Plan of Action. This is our change and this is your chance to influence this". Ultimately, we need to identify if we are doing the same thing, just in different ways and a synthesis of data and research is what is needed in order to move forward.

Visit vrc.crim.cam.ac.uk for more information.

A. Neaverson

Views are my own.

(note: posts are written on-the-go on a mobile app so please excuse any typos and errors)

Wednesday, September 17, 2014

Tonight was the reception drinks and formal dinner for all of us who have arrived for the Global Violence Reduction Conference (see earlier post). As we all got ready at King's College in our guest rooms and student accomodations, we were reminded of our earlier student days, ready to learn.

After venturing over to the Chapel, we entered a space full of specialists from all disciplines and occupations and instantly conversation started to flow. In every group that formed, typical questions were first asked 'Where are you from? What are you presenting?' Then it always led to 'What is your area of research?'. That is when it became clear that what the UBS Optimus Foundation wanted to happen, was actually taking place naturally.

The UBS Optimus Foundation works to support various organisations and projects that have been created to help children who face adversity. The Foundation provides significant financial support to projects that aim to break down barriers that prevent children from realizing their potential.

Patricia Lannen, who is the Programme Director of Child Protection at the UBS Optimus Foundation, has submitted a paper to the conference entitled 'The Role of Philanthropy in the Prevention of Violence against Children'. One key message in this paper is that we need organizations to work together from very different disciplines to create a Violence Prevention Research Capacity and this can not be left in the hands of politicians who are working towards short-term results and are pressured by electoral cycles.

It quickly became evident that discussions around violence prevention were taking place between Political Scientists, Criminologists, Physicians, Psychologists, Members of major Think Tanks from America, Brazil, Mexico and South Africa as well as many other very well established academics. Discussions around the difficulty to get funding for research, access to quality data and lack of political/government support were quite common. But also, similarities between research designs, prediction models and risk and protective factors surfaced. It is evident that there is a very collaborative theme to this conference with the ultimate goal of working together to understand how we can continue to reduce violence globally.

However, the highlight of the night was during dinner when Manuel Eisner (Director of the Violence Research Centre) was named 'Harry Potter'.

With support from the UBS Optimus Foundation, Cambridge University's Institute of Criminology Violence Research Centre (VRC) has collaborated with the World Health Organisation (WHO) to put on an international conference which is set to examine 'Strategies to Reduce Violence by 50% in the Next 30 Years". The VRC aims to advance knowledge of the causes, consequences and prevention of interpersonal violence. The main research interests of the VRC are "The development of aggression over the life-course; Evidence-based violence prevention; The epidemiology and consequences of violent victimisation; The causes for varying levels of violence between societies; and The cross-sectional comparison of risk factors for violence". (www.vrc.crim.cam.ac.uk)

Within the beautiful grounds of King's College in Cambridge, academics, international organisations as well as civil society and philanthropic organisations have come together with the aims to "identify the research we need, the knowledge we have, and the policy recommendations we can make to support the global policy goals of the WHO, especially in the regions most afflicted by violence" (Manuel Eisner, Director of the Violence Research Centre and Deputy & Director of the Institute of Criminology, University of Cambridge).

The WHO were given a mandate to strengthen public policy that supports the reduction of violence. The purpose of this conference is to consider previous and on going research conducted by various academics and organisations around the world as a means to create an informed strategy to reduce violence globally. The mandate, set by the World Health Assembly in May 2014, needs to include strategies which are "informed by measurable indicators to assess whether goals are achieved; it will require strengthening of capacities to address and prevent violence in it's different manifestations; it will need multisectoral action plans and policies to reduce the major risk factors for violence".

A range of topics will be covered over the next two days including:

-Linking Developmental Science and Prevention Research to Intervene More Effectively in Child Development' by Theresa Betancourt from Harvard University

-'Reducing Child Abuse: Tackling Challenges in High Violence Societies' by Bernadette Madrid from University of the Philippines.

-'Global Strategies to Reduce Violence Against Children' by David Finkelhor from University of New Hampshire

-'Treating Violent Offenders More Effectively: Alternatives to Punishment' by Friedrich Loesel from University of Cambridge.

This amazing conference then comes to a finish with a lecture (open to the Public) by Steven Pinker from Harvard University on 'The Past, Present and Future of Violence'. He will address 'the widely-held impression that we are living in extraordinarily violent times, when in fact rates of violence at all scales have been in decline over the course of history'.

Over the course of the next two days, an attempt will be made to blog about sessions, presenters, ideas, concepts and recommendations put forward to realise the goal to reduce violence by 50% in the next 30 years.

A. Neaverson

(Conference blog posts are published on-the-go so please excuse any typos or errors)